Protection During Cardiac Surgery.
- Conditions
- Thoracic SurgeryCardiopulmonary Bypass
- Interventions
- Other: multimodal cardioprotection strategyOther: standard anesthetic procedure
- Registration Number
- NCT03230136
- Lead Sponsor
- Hospices Civils de Lyon
- Brief Summary
This trial investigates whether a multimodal cardioprotection per-surgery therapeutic strategy could reduce myocardial injury in patients undergoing cardiac surgery compared to traditional management. The primary endpoint is the AUC (area under the curve) of the hypersensitive troponin I. Blood samples will be collected during the 72 hours following the aortic cross-unclamping. This trial is a French, multicenter, randomized, single-blinded and controlled trial. 210 patients will be enrolled with a clinical follow-up during 30 days.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 210
- Age > 18 years old
- Aortic valve surgery (aortic valve replacement associated or not with coronary artery bypass graft, Bentall surgery or Tirone David surgery)
- Signed informed consent
- Emergency surgery
- Redo surgery
- Patient treated with Nicorandil, repaglinid or sulfonylurea 48 hours prior to surgery
- Low cardiac output requiring catecholamine infusion or circulatory assistance prior to surgery
- Severe renal failure: dialysis or glomerular filtration rate < 30 mL/min
- Severe liver failure (spontaneous INR >2)
- Severe respiratory insufficiency (VEMS <40% of predicted value)
- Contra-indication to sevoflurane and propofol
- Myocardial infarction < 7 days
- Severe upper limb arterial disease
- Heparin-induced thrombopenia
- Active infection under antibiotic treatment
- Any other surgery combined with the aortic valve surgery: myotomia of Morrow (hypertrophic myocardiopathy), treatment of heart rhythm disorder, inter-atrial communication closure, mitral valve replacement, tricuspid valve replacement, pulmonary valve replacement.
- Pregnant women
- Currently participating in another trial which may interfere with ProCCard results
- Not benefiting from a social insurance or similar system
- Patient under legal protection
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Multimodal cardioprotection therapeutic strategy multimodal cardioprotection strategy - Traditional anesthetic and therapeutic standard anesthetic procedure standard anesthetic procedure No intervention (Control).
- Primary Outcome Measures
Name Time Method Area under the plasma concentration versus time curve (AUC) of Hypersensitive Troponin I at 72 hours Area under the plasma concentration versus time curve (AUC) of Hypersensitive Troponin I determined for each patient with the serial measurement from of troponin I assays.
- Secondary Outcome Measures
Name Time Method Length of mechanical ventilation 30 days 3-level version of EQ-5D (EQ-5D-3L) health status score (quality of life score) Baseline and 30 days The 3-level version of EQ-5D consists of 2 pages: the EQ-5D descriptive system and the EQ visual analogue scale (EQ VAS).It comprises the following five dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each dimension has 3 levels: no problems, some problems, and extreme problems. The patient is asked to indicate his health state by ticking the box next to the most appropriate statement in each of the five dimensions. This decision results into a 1-digit number that expresses the level selected for that dimension. The digits for the five dimensions can be combined into a 5-digit number that describes the patient's health state. The EQ VAS records the patient's self-rated health on a vertical visual analogue scale where the endpoints are labelled 'Best imaginable health state' and 'Worst imaginable health state'. The VAS can be used as a quantitative measure of health outcome that reflects the patient's own judgement.
Length of stay in intensive care unit (ICU) 30 days Number of participants with catecholaminergic support baseline and 30 days Dose of catecholaminergic support baseline and 30 days Adverse events incidence during the first 30 days following surgery of the multimodal cardioprotection strategy 30 days Adverse events will include death, myocardial infarction, heart failure,arrhythmia requiring medical therapy, neurological disorder such as stroke,respiratory insufficiency, any infectious event, major bleeding requiring transfusion of ≥ 5 U packed red blood cells or surgical intervention or surgical complication
Troponin I serum peak value 72 hours Highest serum value recorded for each patient within 72 hours
Length of stay in hospital 30 days Troponin I serum value 24 hours Serum value recorded for each patient within 24 hours
Index Gravity Score (IGS II, the scoring system measuring the severity of disease for patients admitted to ICU) 24 hours Index Gravity Score provides an estimate of the risk of death: the higher the score is, the higher the risk to die is. The maximum score is 163. The Index Gravity Score includes 17 variables: 12 physiology variables, age, type of admission (scheduled surgical, unscheduled surgical, or medical), and three underlying disease variables (acquired immunodeficiency syndrome, metastatic cancer, and hematologic malignancy).
number of death 30 days
Trial Locations
- Locations (8)
CH Annecy
🇫🇷Annecy, France
Service d'Anesthésie-Réanimation, Hôpital Cardiologique et Pneumologique Louis Pradel
🇫🇷Bron, France
CHU de Caen
🇫🇷Caen, France
Clinique de la sauvegarde
🇫🇷Lyon, France
service de Chirurgie Cardiaque CHU Gabriel Montpied
🇫🇷Clermont-Ferrand, France
Unité de Réanimation Cardiovasculaire et Thoracique, Hôpital Michallon
🇫🇷Grenoble, France
Institut Arnault Tzanck - Saint-Laurent du Var
🇫🇷Saint-Laurent-du-Var, France
CHU Saint-Etienne
🇫🇷Saint-Étienne, France